The proposed Lake Superior Rural Cancer Care Project (LSRCCP) is a multidisciplinary and multiinstitutional approach to test strategies for improving cancer diagnosis and management in rural areas of northern Minnesota, northwest Wisconsin, and the western portion of Michigan's Upper Peninsula through education and communication linkages. The long-range objectives of the project are the following: 1) Enhance links between rural health care providers and regional cancer specialists, 2) increase the diffusion and adoption of state-of-the-art cancer care for patients in rural areas. Specific aims of the project will be the following: 1) Increase survival of rural cancer patients, 2) improve the stage at which cancer is diagnosed, 3) increase the proportion of properly staged cancer patients prior to primary treatment, 4) improve the quality and efficiency of cancer management including diagnosis, staging, treatment, and post-treatment surveillance, 5) enhance rural cancer patient and health care providers' participation in clinical trials, 6) study the quality of life and travel burdens of rural cancer patients, 7) improve rural health care providers' knowledge about standard cancer management, 8) determine the relative effectiveness of outreach consultations, telecommunication systems, and educational programs. The study design incorporates a group of control rural sites and a group of treatment/intervention rural sites. There will be stratification of sites which have previously received any form of intervention from the regional community cancer center. Prior to the project's educational and communication linkage interventions, there will be a baseline assessment of all sites. Interventions will include targeted training of physicians, nurses and pharmacists, consultation clinics in the rural sites, communication linkages and quality improvement efforts in the rural sites. The outcome variables will include staging of disease at diagnosis, patient survival, patterns of care analysis, use of the communication system, patient quality-of-life evaluation, and knowledge and behaviors of the health care professionals undergoing educational interventions and receiving communication linkages. Assessment of study variables will be done over four years through surveys of health care providers and patients, abstraction of medical records (inpatient and outpatient), and telephone interviews. Statistical comparisons will determine the effectiveness of each of the interventions as well as the amount of change effected by the total effort. The regional community cancer center (urban site) will consist of the referral hospitals in Duluth, Minnesota, the Duluth Clinic/Duluth Community Clinical Oncology Program, University of Minnesota-Duluth School of Medicine, and the College of St. Scholastica-School of Nursing. The rural sites will consist of 18 communities in the surrounding rural area. A final outcome of the project will be dissemination of the results in reports, published articles, presentations at national conferences, and a conference to be held at the end of the project funding. Following the conclusion of this demonstration project, it is the intention of the applicant organization and its collaborating organizations to continue the interventions shown to be effective. Funding from regional sources will be sought to continue the effective interventions at the study sites, expand the interventions to the control sites, and offer effective interventions to rural sites not included in this demonstration project.